Examination of Witness (Questions 623
- 639)
TUESDAY 11 DECEMBER 2001
MR MIKE
TRACE
Chairman
623. Good morning ladies and gentlemen. This
is the latest of our evidence sessions in our inquiry into the
drugs policy and whether it is working or not. We have received
over 170 submissions, many of them have been flatly contradictory
and we are therefore seeking the help of experts like Mr Trace
to help us pick our way through them. For the record can you state
what your present position is and what your past one was?
(Mr Trace) I am currently the Director
of Performance at the National Treatment Agency, a special health
authority. I am the Chair of the Board of the European Monitoring
Centre on Drugs and Drug Addiction. My past role from October
1997 until June 2001 was Deputy UK Anti-Drugs Co-ordinator.
624. You have worked in the field of drugs policy
for some years, is that right?
(Mr Trace) Drugs treatment. The Deputy Drugs Czar
role was the first policy role I had, although I was on various
committees before. I was a drug treatment practitioner for some
12 years before that.
David Winnick
625. Would you say that the Government's current
drug policy is a success?
(Mr Trace) By the Government's current drugs policy,
I presume you mean the ten-year document Tackling Drugs to Build
a Better Britain.
626. Yes.
(Mr Trace) I am sorry I cannot give you a straight
answer but it is yes and no. There are elements of that strategy
which I am very proud of and I think are working very well. There
are elements which are not achieving the progress that we had
hoped to achieve when we set out the strategy in 1998. My overall
assessment would be very good progress in some areas, the fact
that the strategy is bedded into government policy is a success
in itself, but there are areas where I would have to say, being
an architect of the strategy, I am disappointed in progress.
627. Apart from wanting your view, I asked because
in your paper, which I found very informative indeed, you seem
very pessimistic about the reduction in young people's use of
drugs. You wrote, "The reality of the last three years is
that more and more young people are using cocaine as part of their
social scene". If you had to hazard some sort of guess, how
many more in percentage terms?
(Mr Trace) Trying to reduce prevalence—and the
target is to reduce prevalence by 50 per cent over the ten years
of the strategy—is the area where evidence over the two
to three years of implementation at the moment is showing that
it is not working or not moving in the direction we want it to.
We went for a very significant prevalence reduction because we
thought that was one of the important things Government should
be trying to achieve. The reality of what has happened over the
last few years is that Britain as a high prevalence country—in
European terms we are a high prevalence country of overall drug
use—we have largely stabilised. After the increases we experienced
through the 1980s and 1990s of cannabis use and recreational drug
use such as ecstasy and amphetamines we have stabilised whereas
there are quite large increases in other European countries, but
we are still the highest prevalence country in Europe according
to the surveys which are carried out by the Monitoring Centre.
The percentage increases are actually quite marginal. There are
different surveys which lead to conclusions that there are slight
increases in overall drug use and slight increases in heroin use.
The only significant statistical increase in my interpretation
of the figures is amongst cocaine use by young people. I say in
my written evidence, that I think that is largely linked to the
increase in the youth culture's acceptance of cocaine use as part
of a weekend lifestyle. That is where that blip is coming. I expect
that to be the major prevalence problem, a very intractable prevalence
problem for the drug strategy in the coming years. I also say
in my evidence that I do not think some of the overall continuing
high prevalence of drug use in terms of cannabis use which is
the main driver of those figures is as major a public policy issue
as issues such as cocaine and heroin. I think cocaine is the main
prevalence problem we have at the moment.
628. All those involved in the controversy over
drugs, including those who want a more liberal legislation argue
that nevertheless we should do our utmost to reduce the use of
drugs and therefore there should be the maximum amount of education
in secondary schools, perhaps even primary schools, warning of
the dangers. You write, "While good drug education in schools,
and investments in programmes for marginalised kids may be a good
thing in their own right, they are unlikely to have an impact
on the overall prevalence of youth drug use, and will certainly
not get anywhere near the target of a 50% reduction". In
your view why is it that despite what is happening in schools
and the warnings and the rest of it about what is likely to happen
with drug use, certainly excessive drug use of certain types of
drugs which are dangerous, it is not having an effect?
(Mr Trace) The truthful answer is that I am not entirely
sure. The quality of what is being done in our schools in our
drugs prevention has increased greatly over the last five to ten
years and I should like to think particularly in the last few
years since our strategy was brought in. There is good evaluation
of some of this work to show that procedurally it is very good
work, educationally it meets very high quality standards and that
there are good outputs from that work inasmuch as young people
are better educated, they are more knowledgeable about drugs,
they have better health information with which to protect themselves.
I am not entirely sure why that does not lead to more of them
deciding not to use drugs, but through the surveys it certainly
seems to be the case. I could hazard a guess for you. I would
say that more and more young people, as youth culture develops
generally, more and more young people are risk takers by nature.
They are quite happy with a certain level of risk in their lives
and they are quite happy that drug taking is part of the general
growing up risk they take. It is becoming more normalised. That
is a guess. I could not absolutely say to you that that is actually
happening out there, but that is a social process which is going
on. It is very hard for the state to turn back. It is absolutely
right we should be investing in prevention activities and education
activities around drugs. The only thing I say in my evidence and
I say now is that we should not rely on that to achieve significant
reductions in prevalence which is what we set out to do in 1998.
629. Is it a social class division here? Would
there be any equity in that kids in schools in areas of social
deprivation and the rest are more likely to be prone to it than
say at some public schools or other schools of academic excellence
in the public sector?
(Mr Trace) In terms of overall prevalence I do not
think there is a significant difference. One social process which
has happened over the 1990s is that drug culture and the various
behaviours that go along with drug culture, have embedded themselves
into working class culture just as much as they have into middle
class culture. That obviously has an effect on the numbers we
are talking about and that is not a reversible trend. I do not
think we can change that; once it has happened, it has happened.
There are other countries in Europe and other parts of the world
which have not gone through that process, so their prevalence
rates do not show the same pattern. The big difference in terms
of social class or different types of schools is in terms of the
problem drug use we associate with social exclusion. The main
policy priority in the drug policy, and it is in the 1998 document,
is the extent to which young people get involved in addictive
or problematic patterns of drug use which are mostly associated
with heroin and cocaine. That definitely is bedded much deeper
into poor and working class communities than it is in middle or
upper class communities.
630. Is there a sort of daring? Could a comparison
be made with cigarette smoking, obviously not to the same extent,
but as we know, youngsters growing up like to smoke when they
are under age. Is there a possibility that because drugs are illegal,
there is a sort of daringness about it or would that be an exaggeration?
(Mr Trace) It could work either way. There are surveys
which would lead one to either conclusion. If you do surveys of
young people and ask them why they use drugs or do not use drugs,
very few of them say they did it because it made them look adult
or they did it because it showed them to be daring. Quite a few
who do not use drugs mention the fact that they are illegal as
a reason not to use drugs. The legal status is relevant to some
of those people's decision. I have to say it is not the majority
or anywhere near the majority, but it is referred to by young
people as an aspect in their decision making. It comes way below
the health risk. Health risk tends to come top, attitude of parents
comes next, not necessarily whether the parents are supportive
or going to kick them out or anything, but it is whether their
parents will find out and approve. Those at the two high ones,
but the legal status does figure in there. On the other side,
in my understanding of youth culture, and it is some time since
I was part of it, this issue of trying out something which is
slightly beyond the pale is absolutely an essential part of youth
culture—"essential" is perhaps not the best word
to use. Young people do want to try out things they see as adult
or a bit dangerous. As with tobacco smoking, twelve-year-olds
think tobacco smoking makes them look like fifteen-year-olds,
fifteen-year-olds think cannabis smoking makes them look like
eighteen-year-olds. That happens in youth culture in my view.
631. Something which is forbidden and there
is some satisfaction in breaking the taboos.
(Mr Trace) Yes. We would not put figures on that or
draw it as a causal link, but I do think that process happens
in young people's minds.
632. You say that the structured approach of
the UK strategy has been seen as a model by the international
community, which has been followed by a number of other countries.
Why should that be so? After all, it could hardly be said that
our policy is so successful that other countries should follow
us.
(Mr Trace) Absolutely. There was a statement by one
of your members in one of the previous sessions which referred
to the operation being a success but the patient being dead. That
came home quite strongly to me. The dilemma for many years in
drug policy, either national, global or European, has been that
until the mid-1990s nobody had made a serious attempt to bring
together all the complex strands of how drugs affect a western
society and bring together all these issues of how you link up
your education work to your treatment work, how you link up your
social inclusion policy to your drugs policy, how you link the
supply-side efforts with the demand-side efforts. Truly in my
view, and somebody may prove me wrong with an historical document,
the UK drug strategy of 1998 was the most sophisticated attempt
to bring all those strands together, identify what the overarching
objectives were and bring all of that morass of activities together
into a government programme. That did have a very big impact in
things like United Nations, the European Union. Many other countries,
very quickly because they were looking also for solutions to this
same issue, latched onto that as a way of going about writing
a drug policy. My claims for its value are mainly in terms of
giving people a structure by which to consider some very complex
issues rather than its outcome success. There are two areas where
we can claim outcome success but certainly not across the board.
633. Are we as a country better, worse or much
the same as other Western European countries when it comes to
the drug scene? Are there more drugs here than elsewhere?
(Mr Trace) What aspect are you asking about, the prevalence
of use?
634. Yes, of actual use.
(Mr Trace) In terms of prevalence of use we are the
highest prevalence country in Europe.
635. Of all countries in Europe?
(Mr Trace) Yes, of all countries in Western Europe.
The way we measure this is that we do annual or biannual surveys
of all people. We have a youth survey which is done with schoolchildren
and we have a survey as part of the British Crime Survey which
asks people a regular set of questions which are now international
norms. We ask people whether they have used certain drugs ever,
whether they have used certain drugs in the last 12 months and
whether they have used certain drugs in the last month. We have
a series of those surveys since the mid-1990s in many countries
of Europe and consistently the UK comes first and consistently
I have to sit in front of a press conference at the European Monitoring
Centre and answer all the questions about Britain being the worst
and so on. That is on overall drug prevalence, the number of people
who report they have ever used these drugs. When you look at use
last month you are basically reporting on the number of people
who are current users of drugs and there is a big difference.
Of all the people who have ever used drugs, the vast majority
of them are not current users now. On both indicators the UK comes
top of the European league. There may be six or seven other countries
which are the same sort of level as us in overall prevalence,
countries such as France, Spain, Portugal, Denmark and Holland,
but three or four per cent below on most of these indicators;
the same sort of broad picture but they are consistently just
below us. Then there are several countries like Sweden or Finland
who have very low prevalence rates.
636. Can you give any explanation why we should
be top of the league? It is top of the sort of league where hopefully
most people would not wish to see us. Why Britain?
(Mr Trace) Culture. I was going to say geography,
but that would not explain an awful lot of it. Youth culture.
If you think about British youth culture, cannabis became embedded
into youth culture much earlier than it did in most other European
countries and the big growth of drug use and the normalisation
of drug use happened in the UK in the late 1980s with the changes
in youth culture then. It just hit the UK much earlier than it
hit most other countries. The most similar history of youth culture
we have in any other European country is Holland, which does have
broadly similar prevalence rates to us; slightly lower but broadly
similar historical growth of drug use. Doing European comparisons
always makes us look bad, but we do have lower prevalence rates
than the US and Australia. We are not the worst in the world.
One very important part of my written evidence is that using overall
prevalence as the main indicator of the success of a drug strategy
is the fundamental flaw in what we did in 1998. I do not think
that overall prevalence is your best indicator of the harm being
caused to a society by the use of drugs.
Chairman
637. What is the best indicator?
(Mr Trace) There are three or four and we have failed
to define a couple of them which is a real shame. The four indicators
I really think we should be going for relate to the consequential
harm of the use of drugs. They are: drug-related crime—we
have that in the strategy; drug-related public health damage and
there are two sub-indicators in there which would be overdose
deaths and infections of HIV and hepatitis; drug-related social
exclusion. I have referred to the last one in my written evidence.
I think that is the most important thing we should be concentrating
on in our drug policy, but because it is so amorphous and because
it is so hard to develop a pure research indicator on it, it has
not been one of the headlines of the drug strategy and that has
been a real difficulty. What a country should be trying to achieve
is to minimise those four harms rather than looking at the overall
prevalence rate.
Chairman: We shall expand on that in a moment.
Mr Prosser
638. Sticking with prevalence. When other witnesses
have come before the Committee, people who are driving the present
drug strategy, people like Keith Hellawell, Home Office Ministers,
etcetera, and we have asked them whether the policy was working,
you might have expected them to say it is working. When we press
them on the issues we have pressed this morning and show them
the record they use as a defence that it is only three years into
a ten-year strategy and it will all be all right in the end. They
do not quite say that, but that is the sort of view they give.
Even when we press them harder on their expectation of meeting
the targets, even the 50 per cent target, they are cautiously
optimistic. Why do you take such a different view? Is it because
you are not now part of that strategy? Before you left your last
appointment, did you try to convince your colleagues and Ministers
that some of the targets were perhaps wrongly set and that some
of the strategy should be implemented in different ways?
(Mr Trace) To answer your difficult question first,
I am rather freer to speak now but I still work for the Government;
I work for the Department of Health. To answer the next part of
your question, broadly I have sympathy with that view. One of
the very important things we said, which I regret that most of
the press and particularly most of the House, do not seem to have
remembered, was that anybody who promises to turn around the role
of drugs and the use of drugs in society in a parliamentary term
is lying. We said that in 1998. You do not change these basic
social processes in two to three years. So I do have some sympathy
with their position, "Give it time". I also have some
sympathy with the position that the drug strategy is generally
the right framework to follow through these actions. It is a very
strong managerial framework, it has all the government departments
signed up to it, has all the Ministers signed up to it. That is
very important and you do not want to pull that apart. Where I
have diverged is to say that I absolutely agreed in 1998 that
we should be setting a very ambitious target to reduce prevalence.
Why have a drug strategy if you are not intending to change things?
All I am saying is that over three to four years we have to look
at the evidence which is developing and my look at the evidence
which is developing is that we should be much more pessimistic
about that side of the strategy. That is all I am saying. I am
not saying the strategy is wrong or failing. I am saying that
on that issue, reducing prevalence, the actions we have put in
place over the last few years are not having an impact yet. You
could respond to that reality two ways. You could say stick with
it, give it a few more years and see how it goes, or you could
say that you need to think again and you need to approach this
a bit differently. I am tending to the latter. I think it is still
valid. There is no proof to say that to stick with that as a target
is wrong, but I am tending to pessimism at the moment.
639. On the question of prevalence, you made
the point that it should not be one of the targets. How would
you advise us? We would have to prepare the public for that story,
would we not? If we said we now do not look upon prevalence as
the main issue it is all about harm reduction, etcetera, and I
have some sympathy with that, how would we prepare the ground
in terms of public perceptions?
(Mr Trace) I am not arguing to remove it as a target.
What I am saying is prevalence is not the main thing we should
be trying to achieve; a reduction in prevalence is not the main
thing we should be trying to achieve. It still is a key indicator;
obviously we need to know how many people are using drugs. Where
I worry is about the allocation of resources. Target setting in
government has a large impact on how resources are prioritised.
If there is a key manifesto target or a key government strategy
target, then it is going to attract resources. Where it starts
to get difficult and over-prioritising the prevalence issues you
find that the resources will go towards trying to achieve that
target. It is a matter of resource allocation and balance of resource
allocation in my view. Within the available resources we should
be concentrating much more on programmes which reduce public health
damage and programmes which reduce social exclusion. I am not
really asking for a radical re-think of the strategy. The strategy
is broadly the right framework. I am asking for a different prioritisation
of resource allocation.
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